Provider Demographics
NPI:1376711200
Name:HERRICK, JULIE M (LMSW-CC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:HERRICK
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 W COLE RD
Mailing Address - Street 2:STE 103
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9431
Mailing Address - Country:US
Mailing Address - Phone:207-571-9923
Mailing Address - Fax:207-571-9927
Practice Address - Street 1:22 W COLE RD
Practice Address - Street 2:STE 103
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9431
Practice Address - Country:US
Practice Address - Phone:207-571-9923
Practice Address - Fax:207-571-9927
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LC121041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431492200Medicaid
432291100Medicare PIN